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Mental illness and suicide after self-harm among young adults: long-term follow-up of self-harm patients, admitted to hospital care, in a national cohort

Published online by Cambridge University Press:  20 September 2016

K. Beckman ,
E. Mittendorfer-Rutz ,
P. Lichtenstein ,
H. Larsson ,
C. Almqvist ,
B. Runeson  and
M. Dahlin
K. Beckman*
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden
E. Mittendorfer-Rutz
Affiliation:
Department of Clinical Neuroscience, Insurance Medicine, Karolinska Institutet, Stockholm, Sweden
P. Lichtenstein
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden
H. Larsson
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Department of Medical Sciences, Örebro University, Örebro, Sweden
C. Almqvist
Affiliation:
Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden Astrid Lindgren Children's Hospital, Karolinska University Hospital, Stockholm, Sweden
B. Runeson
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden
M. Dahlin
Affiliation:
Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet and Stockholm Health Care Services, Stockholm City Council, St Goran, Stockholm, Sweden
*
*Address for correspondence: Dr K. Beckman, Department of Clinical Neuroscience/Stockholm County Council, Centre for Psychiatric Research and Education, Karolinska Institutet, St Goran, Sweden. (Email: [email protected])
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Abstract

Background

Self-harm among young adults is a common and increasing phenomenon in many parts of the world. The long-term prognosis after self-harm at young age is inadequately known. We aimed to estimate the risk of mental illness and suicide in adult life after self-harm in young adulthood and to identify prognostic factors for adverse outcome.

Method

We conducted a national population-based matched case-cohort study. Patients aged 18-24 years (n = 13 731) hospitalized after self-harm between 1990 and 2003 and unexposed individuals of the same age (n = 137 310 ) were followed until December 2009. Outcomes were suicide, psychiatric hospitalization and psychotropic medication in short-term (1-5 years) and long-term (>5 years) follow-up.

Results

Self-harm implied an increased relative risk of suicide during follow-up [hazard ratio (HR) 16.4, 95% confidence interval (CI) 12.9–20.9). At long-term follow-up, 20.3% had psychiatric hospitalizations and 51.1% psychotropic medications, most commonly antidepressants and anxiolytics. There was a six-fold risk of psychiatric hospitalization (HR 6.3, 95% CI 5.8–6.8) and almost three-fold risk of psychotropic medication (HR 2.8, 95% CI 2.7–3.0) in long-term follow-up. Mental disorder at baseline, especially a psychotic disorder, and a family history of suicide were associated with adverse outcome among self-harm patients.

Conclusion

We found highly increased risks of future mental illness and suicide among young adults after self-harm. A history of a mental disorder was an important indicator of long-term adverse outcome. Clinicians should consider the substantially increased risk of suicide among self-harm patients with psychotic disorders.

Keywords

Longitudinal studiesmental disordersself-harmsuicideyoung adult
Type
Original Articles
Information
Psychological Medicine , Volume 46 , Issue 16 , December 2016 , pp. 3397 - 3405
Copyright
Copyright © Cambridge University Press 2016 

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